Lymphadenectomy issues in endometrial cancer

Area of Science:

• Gynecologic Oncology
• Surgical Oncology
• Clinical Trials

Background:

• Endometrial cancer management often involves lymphadenectomy to assess lymph node metastasis (LNM).
• Accurate preoperative prediction of LNM is crucial for optimizing surgical strategies and patient outcomes.
• The therapeutic role of lymphadenectomy, particularly para-aortic lymphadenectomy, requires further investigation.

Purpose of the Study:

• To review and evaluate preoperative scoring systems for predicting LNM in endometrial cancer.
• To compare ongoing clinical trials investigating the survival benefit of lymphadenectomy.
• To describe the JCOG1412 trial and its quality assurance measures.

Main Methods:

• Summarized previous reports on preoperative LNM prediction models.
• Evaluated the validity of these models in recent cohorts.
• Compared characteristics of two ongoing lymphadenectomy trials (JCOG1412, ECLAT).

Main Results:

• Lymphadenectomy was successfully omitted in 64 low-risk endometrial cancer patients using a scoring system, with no observed lymphatic failure.
• Two ongoing phase III randomized trials (JCOG1412, ECLAT) are evaluating the survival benefit of lymphadenectomy.
• The JCOG1412 trial demonstrated high quality of surgical procedures, with well-controlled lymphadenectomy.

Conclusions:

• The developed scoring system strategy for omitting lymphadenectomy appears reasonable and generalizable.
• High-quality surgical procedures in JCOG1412 are expected to yield definitive conclusions on the therapeutic role of lymphadenectomy.
• Further research is needed to refine LNM prediction and surgical decision-making in endometrial cancer.